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                                                            ORIGINAL RESEARCH

       UPDATE – Canadian Urological Association

       guideline: Male lower urinary tract symptoms/

       benign prostatic hyperplasia

       Dean Elterman , Mélanie Aubé-Peterkin , Howard Evans , Hazem Elmansy , Malek Meskawi , Kevin C. Zorn ,
       Naeem Bhojani  5
       1 Division of Urology, University of Toronto, Toronto, ON, Canada;  Division of Urology, McGill University, Montreal, QC, Canada;  Division of Urology, University of Alberta, Edmonton, AB, Canada;  Division
       of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada;  Division of Urology, Université de Montréal, Montreal, QC, Canada
       Cite as: Elterman D, Aubé-Peterkin M, Evans H, et al. UPDATE – Canadian Urological Association   with causes other than BPO may require more extensive
       guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J   diagnostic workup and different treatment considerations.
       2022;16(8):245-56.  We acknowledge that not all patients identify as male. These
                                                             guidelines should also be applicable to non-binary people,
                                                             transwomen, and any patients who may have anatomical
       Published online April 11, 2022
                                                             features of a cis-male genitourinary tract, such as a prostate.
                                                             It is our intent to make these guidelines inclusive to all per-
                                                             sons experiencing LUTS or an enlarged prostate.
       Introduction                                             In this document, we will address both diagnostic and
                                                             treatment issues. Diagnostic guidelines are described in the
       The current document summarizes the state-of-the-art know-  following terms as: mandatory, recommended, optional, or
       ledge as it relates to management of male lower urinary tract   not recommended. The recommendations for diagnostic
       symptoms (MLUTS) secondary to benign prostatic hyperplasia   guidelines and principles of treatment were developed on the
       (BPH) by updating the 2018 Canadian Urological Association   basis of clinical principle (widely agreed upon by Canadian
       (CUA) BPH guideline.  The process continues to highlight the   urologists) and/or expert opinion (consensus of committee
       essential diagnostic and therapeutic information in a Canadian   and reviewers). The grade of recommendation will not be
       context. The information included in this document includes   offered for diagnostic recommendations. Guidelines for
       that reviewed for the 2010 guideline and further information   treatment are described using the GRADE approach  for
       obtained from an updated MEDLINE search of the English-  summarizing the evidence and making recommendations.
       language literature (search terms included BPH, alpha-block-
       ers, 5-alpha reductase inhibitor, anti-cholinergic, beta3 agon-  1. Diagnostic guidelines
       ist, phosphodiesterase type 5 inhibitor [PDE5I], transurethral
       resection of the prostate [TURP], monopolar, bipolar, open   The committee recommended minor revisions in regard to
       simple prostatectomy, enucleation, GreenLight, photoselect-  diagnostic considerations as outlined in the 2018 CUA BPH
       ive vaporization of the prostate [PVP], Aquablation, Rezum,   guideline.
       UroLift, temporarily implanted nitinol device [iTiND]), as well
       as review of the most recent American Urological Association   1.1. Mandatory
       (AUA)  and European Association of Urology (EAU) guide-
       lines.  References include those of historical importance, but   Mandatory evaluations include:
       management recommendations are based on literature pub-  -   History
       lished between 2000 and 2021. When information and data   -   Physical examination, including DRE
       is available from multiple sources, the most relevant (usually   -   Urinalysis
       most recent) article is cited based on committee opinion.  In the initial evaluation of a man presenting with LUTS,
         These guidelines are directed toward the typical male   the evaluation of symptom severity and bother is essen-
       patient over 50 years of age presenting with LUTS and benign   tial. Medical history should include relevant prior and cur-
       prostatic enlargement (BPE) and/or benign prostatic obstruc-  rent illnesses, as well as prior surgery and trauma. Current
       tion (BPO). It is recognized that men with LUTS associated   medication, including over-the-counter drugs and phyto-

                                                 CUAJ • August 2022 • Volume 16, Issue 8                      245
                                                  © 2022 Canadian Urological Association
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